Moderate
Enalapril × Hydrochlorothiazide
Angiotensin-converting enzyme inhibitors (ACEi)×Thiazide diuretics
Mechanism
Additive antihypertensive effect. In the first weeks hydrochlorothiazide increases renin-angiotensin system activity, raising sensitivity to the ACE inhibitor. A standard fixed combination for arterial hypertension.
Symptoms
Symptomatic hypotension on starting: dizziness, weakness, especially on standing. In older patients: fall risk. Potassium monitoring matters — thiazide depletes, ACE inhibitor retains.
Management
On starting the combination, begin enalapril at the lowest dose (2.5 mg) at bedtime. Check creatinine and potassium at 1–2 weeks, then every 6 months. In older patients, take the first dose seated.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Sources
- Lexicomp: Lexicomp Drug Interactions (2024)– Wolters Kluwer Clinical Drug Information, Inc. Lexi-Interact Online, 2024
- Pharmaceutical Press: Stockley's Drug Interactions, 12th edition (2024)– Preston CL (ed.). Stockley's Drug Interactions. 12th ed. London: Pharmaceutical Press; 2024